Healthcare Provider Details

I. General information

NPI: 1912943036
Provider Name (Legal Business Name): MICHELE M STOCKTON DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 W LAKE ST
TAWAS CITY MI
48764
US

IV. Provider business mailing address

1113 W LAKE ST PO BOX 207
TAWAS CITY MI
48763-9304
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-9910
  • Fax: 989-362-8198
Mailing address:
  • Phone: 989-362-9910
  • Fax: 989-362-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007273
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: